Functional Seizures commonly referred to as Non-epileptic seizures (NES) is a descriptive term for a diverse group of disorders which refers to paroxysmal events that can be mistaken for epilepsy, but are not due to an epileptic disorder. There are two sub-categories of Functional Seizures (NES):
- Physiological: includes a broad spectrum of disorders, eg syncope, paroxysms of acute neurological insults, paroxysmal toxic phenomena, non-toxic organic hallucinosis, non-epileptic myoclonus, sleep disorders, paroxysmal movement disorders, paroxysmal endocrine disturbances and transient ischaemic attacks (TIAs). Several factors can trigger a physiologic seizure such as abnormal sleeping patterns, excessive amounts of alcohol, fainting spells, hypoglycemia, low blood pressure, and other physiological conditions that affect the sugar and oxygen levels as well as the flow of blood into the brain.
- Psychological: These type of seizures include different types:
- Dissociative seizures are involuntary and happen unconsciously. This is the most common type of NES and the person has no control over the seizures.
- Associated with psychiatric conditions that cause seizures, eg panic attacks.
The true prevalence is unknown. However, it is estimated that up to one-quarter of patients admitted to epilepsy monitoring unit for evaluation of are ultimately diagnosed as having Functional Seizures.
Management is directed at treating the underlying cause.
Various treatments have been tried with variable success for psychogenic Functional Seizures. Treatment regimes for Functional Seizures include non-psychological, eg anti-anxiety and antidepressant medication and psychological therapies (including cognitive behavioral therapy, hypnotherapy, and paradoxical injunction therapy). With paradoxical injunction therapy, the therapist imposes a directive that places the client in a therapeutic double bind that promotes change regardless of the client’s compliance with the directive.
There is currently no reliable evidence to support the use of any treatment, including hypnosis or paradoxical injunction therapy, in the treatment of Functional Seizures(NES).
The differentiation between epileptic and non-epileptic seizures
The differentiation between epileptic and Functional (non-epileptic) seizures can be difficult.
Medical causes of transient neurological dysfunction (with or without loss of consciousness).
- Syncope: vasovagal, cardiogenic.
- Neurological: cerebrovascular, migraine, vertigo, cataplexy, parasomnias, movement disorders, startle-induced phenomena.
- Endocrine and metabolic: hypoglycaemia, hypocalcaemia, hereditary fructose intolerance.
- Drugs and alcohol.
- Psychiatric disorders that may be mistaken for epilepsy: panic disorder, psychosis, attention deficit hyperactivity disorder, depersonalization disorder.
- Dissociative seizures
A significant number of patients (estimated at up to 30%) having mixed epileptic and functional seizure disorders.
Understanding Epilepsy may help you better understand Non-Epilepsy
Epilepsy is not one single disorder. It is more a term to describe a set of symptoms which may be associated with several neurological disorders. In general, someone with ‘epilepsy’ will suffer from seizures, which themselves vary enormously depending upon the precise nature and manifestation of the initial disorder.
Seizures are caused by large amounts of electrical activity within the brain. Around 50 million people worldwide are epileptic, with more new-onset cases occurring in the very young and very old. People suffering from brain injuries, or recovering from brain surgery may also suffer from epileptic seizures. Seizures themselves can vary from brief slips of attention to full-body convulsions. It is worth noting that having a seizure does not necessarily make one epileptic, as not all seizures are caused by epilepsy.
The prognosis for epilepsy depends upon the cause of it. In general, epilepsy cannot be cured, but it can be controlled through the use of drugs. Many patients find the drugs so successful that they rarely if ever experience a seizure. Others may need to have surgery in order to reduce their seizures. Some patients – particularly if their symptoms manifest in infancy – grow out of epilepsy. For this reason, it is generally inadvisable to operate on a small epileptic child (although this naturally varies depending upon the precise root of the disorder).
Epileptic seizures are usually spontaneous, but some may occur in response to external triggers. ‘Reflex epilepsy’, as it is known, can cause seizures in the event of things like stress, overheating, exhaustion, and even sleep. Some women experience Catamenial epilepsy – which happens due to the female menstrual cycle. Often, epileptic triggers differ in different age groups. Adolescents, for example, are more likely to experience CND or lesion-related seizures, while the elderly may have seizures related to cerebrovascular disease. However, these are not by any means the only causes of epilepsy. Generalized epilepsy is most commonly caused by gene mutations.
There are several types of seizures. One may have partial/focal onset seizures or distributed generalized seizures. Partial seizures are further categorized as partial or complex partial seizures. These vary from absence (petit mal) seizures to tonic-clonic (full-body) seizures. Epilepsy itself comes in four main types, which are themselves further divided into sub-groups based upon the location, nature, and cause of the cerebral seizure activity. Your doctor will be able to explain this more fully.
Seizure sufferers can take heart from the fact that many seizure medications have proven extremely effective, and advances are occurring in the field all the time. Should you know a seizure sufferer, or encounter somebody having a seizure, the best thing that you can do is to remove sharp object(s) from their vicinity, protect their head, and leave them to it. If necessary, roll them onto their side. There is a myth that one must put something in a seizing individual’s mouth to prevent them from biting their tongue – in fact, this often just results in the sufferer breaking their teeth.
DESCRIBING DISSOCIATIVE SEIZURES (article)
“There are lots of different types of seizures, and they happen for many different reasons. Some are caused by conditions such as low blood sugar (hypoglycaemia) or a temporary change to the way the heart is working.”
“What seizures all have in common is that they are usually sudden, short, and cause a change in the person’s awareness of where they are, what they are doing, what they are thinking or what they are feeling.”
“Some people have more than one type of seizure. For example, around 15 in every 100 people with non-epileptic seizures (NES) also have epilepsy.”
“If you, or someone you know, has been diagnosed with non-epileptic seizures it may be helpful for you to identify the type of seizures that are relevant to you, and how you feel about them.”